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Inflammation block > Inflammatory bowel disease > Flashcards

Inflammatory bowel disease Flashcards

1
Q

What are the different types of IBD

A
  1. ) Ulcerative Colitis

2. ) Crohn’s disease

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2
Q

What are the characteristics of ulcerative colitis

A
  • Inflammatory disorder affecting the mucosa of the large colon
  • Onset: bimodal 20-30 and 50
  • suggested genetic component
  • M:F 1:1
  • White superficial ulcers
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3
Q

Describe the pathophysiology of UC

A

-Exaggerated mucosal T cell response to host microbiota and/or external stimulae in context of genetically receptive host

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4
Q

What are the symptoms of UC

A
  • Rectal bleeding
  • Diarrhoea
  • Urgency
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5
Q

How is UC diagnosed?

A
  1. ) Blood tests
    - Raised CRP/ESR
    - Anaemia
    - Low albumin
  2. ) Faecal calprotectin
  3. ) Endoscopy
    - gold standard
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6
Q

What is faecal calprotectin

A

-Substance that is released into the intestines in excess when there is any inflammation there

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7
Q

How can we classify UC

A
  • Proctitis
  • Left-sided colitis
  • Pancolitis

Usually moves more distally so progresses from proctitis to pancolitis

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8
Q

What is pancolitis

A
  • refers to the dfegree of UC
  • The whole of the LI is affected
  • full name is pan-UC
  • sometimes referred to as total colitis or universal colitis
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9
Q

How can we treat UC

A

1.) steroids: prednisolone
2.) Aminosalicylates(oral and rectal)- mesavat,octasa
3.)Immunosuppressants- azathioprine, methotrexate
4.) Biologics: anti-TNF-infliximab, salimumab
anti-integrin-vedolizumab
5.) Surgery-up to 15% over lifetime

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10
Q

What is subtotal colectomy?

A
  • Removing part of the colon

- Partial colectomy

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11
Q

Define total colectomy

A

-Removing all of the colon

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12
Q

Define hemicolectomy

A

Removing the right or left portion of the colon

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13
Q

Define proctocolectomy

A

Removing both the colon(total/partial) & the rectum

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14
Q

Outline the use of pouches in UC, including it’s complications

A
  • If your UC inflammation and symptoms haven’t been controlled by medications, your doctor may have recommended a common type of surgery to construct an ileal pouch anal anastomosis, or (IPAA). It involves removing the colon and rectum to form a j-pouch.
  • pouchitis: bacteria population the ileum(normally sterile) so you get this low level inflammation—> some patients will have to have the pouch removed & have a permanent stoma after that
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15
Q

What are the complications of J pouches

A

-frequent/urgent trips to the loo
-in women there is a high risk of inferitlity after
-

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16
Q

What a stoma?

A

A stoma is where a section of bowel is brought out through an opening on your stomach area (abdomen). Your bowel movements (poo) are collected in a pouch or bag attached to the skin around your stoma.

17
Q

What is a colostomy ?

A

a stoma formed by bringing part of your colon (large bowel) out on to the surface of your abdomen. The waste from a colostomy is usually more formed than from an ileostomy, as it has had some of the water removed on its way around the bowel.

18
Q

What is the trulove & witt criteria

A
  • In practice we now use CRP as this is more accurate
  • helps us to decide whether to admit an IBD pt
  • Factors include: motions per day; rectal bleeding; temp; pulse rate; haemoglobin; ESR
  • Split into mild, moderate & severe
19
Q

How can we assess an IBD pt

A
  1. ) Examination: dehydration, abdominal tenderness, bowel sounds
  2. ) Blood tests: FBC, U&Es, LFTs, CRP
  3. ) Imagining-CXR & AXR
  4. ) Stool tests- MC& S, C.diff
  5. ) Sigmoidoscopy to exclude CMV superadded infection
20
Q

What is toxic megacolon

A

a potentially lethal complication of inflammatory bowel disease (IBD) or infectious colitis that is characterized by total or segmental nonobstructive colonic dilatation plus systemic toxicity

21
Q

What is leadpipe colon

A

The lead pipe appearance of colon is the classical barium enema(an X-ray exam) finding in chronic ulcerative colitis. There is complete loss of haustral markings in the diseased section of colon, and the organ appears smooth-walled and cylindrical

22
Q

What are the characteritsics of Crohn’s disease?

A
  • Chronic inflammatory trans-mural inflammation
  • M:F: 1:1
  • Peak onset age 20-30
23
Q

Outline the aetiology of Crohn’s disease

A
  • Exaggerated T cell inflammatory response to environmental factors in presence of genetically susceptible host
  • Microbiota: ‘hygiene hypothesis’
  • Genetics-58% monozygotic twins
24
Q

Outline the hygeine hypothesis for Crohn’s disease

A

multiple childhood exposures to enteric pathogens protect an individual from developing Crohn’s disease later in life, while individuals raised in a more sanitary environment are more likely to develop Crohn’s disease.

25
Q

Outline the disease distribution for Crohn’s disease

A
  • Ileo-colonic
  • Ileal
  • Colonic
  • Perianal
  • Upper GI
26
Q

What are the symptoms of Crohn’s disease

A
  • Diarrhoea
  • Rectal bleeding
  • Abdominal pain
  • Weight loss(more prominent cos it’s a small bowel disease)
  • Perianal abscess
  • Oral ulceration
27
Q

What are the signs of Crohn’s disease

A
  • Cachexia( weakness and wasting of the body due to severe chronic illness)
  • Scars
  • Stomas (often 2-3)
  • Parenteral nutrition (i.v administration of nutrition)
28
Q

Why do we avoid operating on pts with Crohn’s disease

A
  • Cos surgery is never a cure for this

- Minimise invasion and risks eg of infection

29
Q

How can we diagnose Crohn’s disease?

A
  1. ) Blood tests: anaemia, low B12, folate, ferritin, low albumin
  2. ) Faecal calprotectin
  3. ) Endoscopy &histology
  4. ) Imaging- MRI small bowel, MRI pelvis and small bowel USS
30
Q

Outline the treatment options for Crohn’s disease

A
  1. ) Steroids: prednisolone, budesonide
  2. ) Antibiotics: ciprofloxacin, metronidazole
  3. ) Immunosuppressants: azathioprine, mercaptopurin, methotrexate
  4. )Biologics: infliximab, adalimumab, golimumab, vedolizumab, ustekinumab
  5. ) Modulen-anti-inflammatory properties. Esp useful in paediatric and pre-surgery
  6. ) Surgery

1&2 are particularly useful short term treatments

31
Q

Outline use of surgery in Crohn’s disease

A
  • Up to 70% will have surgery in their lifetime
  • Examination under anaesthetic ( EUA)- perianal abscess/fistula
  • Stricturoplasty: removal of small bowel stricture
  • Colectomy
  • Diverting colostomy
32
Q

State the differences between UC and Crohn’s disease

A
  1. ) Distribution: UC=only colon ; CD= mouth->anus
  2. )Inflammation depth: UC=mucosal inflammation only CD=transmural inflammation
  3. ) Presence of fistulas= only present in CD
  4. ) Presence of strictures= only present in CD
  5. ) Histology: UC= crypt abcesses and mucosal inflammation CD= granulomas & transmural inflammation
  6. ) Smoking= protective in UC ; detrimental= CD
33
Q

What is key in treatment of acute colitis

A

Steroids

-Day 3 assessment to decide on rescue therapy or surgery

34
Q

What should we ensure about drug and ab levels when treating IBD

A

-That we manipulate them to optimise medical treatment

Inflammation block (27 decks)

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